As COVID-19 devastates already fragile health systems, over 6,000 additional children under five could die a day, without urgent action
UNICEF launches #Reimagine, a global campaign to prevent the pandemic from becoming a lasting crisis for children
DHAKA/NEW YORK, 13 MAY 2020 – An additional 6,000 children could die worldwide every day from preventable causes over the next six months as the COVID-19 pandemic continues to weaken health systems and disrupt routine services, UNICEF said today.
In Bangladesh too, uptake of critical health services for under-five children has decreased significantly due to the COVID-19 pandemic. The service utilization for children under 5 years of age in March 2020 was down 25 per cent compared to March 2019.
“A large number of children could die from preventable and treatable conditions if the pandemic leads to substantial reductions in health service coverage. UNICEF is working closely with the Government of Bangladesh to help ensure that lifesaving care for children and mothers is available, safe and accessible,” said Tomoo Hozumi, UNICEF Country Representative in Bangladesh.
The uptake of maternal and newborn health services has also decreased, approximately by 19 per cent. In addition, key maternal health services such as antenatal care visits and postnatal checkups in health facilities have decreased substantially, and deliveries in facilities have decreased by 21 per cent for the period of January to March 2020 compared with October to December 2019.
Due to the pandemic, Bangladesh had to postpone a measles and rubella immunization campaign targeting 34 million children aged 9 months to 9 years. Though routine immunization sessions continue, many outreach sessions have been suspended and the transportation of vaccines remains challenging.
A new analysis projects that if there is further reduction in health services in Bangladesh, more than 28,000 children under the age of five could die in next six months as an indirect result of the pandemic in worst case scenario. Wasting, a severe form of malnutrition, would be a significant contributory factor to such under-five deaths.
While the health system has had to give much of its attention to the COVID-19 pandemic response, which is very important, UNICEF is also working with the Ministry of Health and Family Welfare to maintain routine essential maternal, newborn and child health services which have equally important consequences for children and women. The Ministry has recruited an additional 2,000 doctors and 5,000 nurses to help overcome the challenges. Additional investments in health are needed now more than ever to strengthen the health system in Bangladesh.
The above-mentioned mortality estimates are based on an analysis by researchers from the Johns Hopkins Bloomberg School of Public Health, newly published in The Lancet Global Health journal. Based on the worst of three scenarios in 118 low- and middle-income countries, the analysis estimates that an additional 1.2 million under-five deaths could occur in just six months, due to reductions in routine health service coverage levels and an increase in child wasting.
These potential child deaths will be in addition to the 2.5 million children who already die before their 5th birthday every six months in the 118 countries included in the study, threatening to reverse nearly a decade of progress on ending preventable under-five mortality.
Some 56,700 more maternal deaths could also occur in just six months, in addition to the 144,000 deaths that already take place in the same countries over a six-month period.
“Under a worst-case scenario, the global number of children dying before their fifth birthdays could increase for the first time in decades,” said UNICEF Executive Director Henrietta Fore. “We must not let mothers and children become collateral damage in the fight against the virus. And we must not let decades of progress on reducing preventable child and maternal deaths be lost.”
In countries with already weak health systems, COVID-19 is causing disruptions in medical supply chains and straining financial and human resources. Visits to health care centres are declining due to lockdowns, curfews and transport disruptions, and as communities remain fearful of infection. In a commentary to the Lancet report, UNICEF warns these disruptions could result in potentially devastating increases in maternal and child deaths.
The paper analyzes three scenarios for the impact of reductions in lifesaving interventions due to the crisis on child and maternal deaths. It warns that in the least severe scenario, where coverage is reduced around 15 per cent, there would be a 9.8 per cent increase in under-five child deaths, or an estimated 1,400 a day, and an 8.3 per cent increase in maternal deaths. In the worst-case scenario, where health interventions are reduced by around 45 per cent, there could be as much as a 44.7 per cent increase in under-five child deaths and 38.6 per cent increase in maternal deaths per month. These interventions range from family planning, antenatal and postnatal care, child delivery, vaccinations and preventive and curative services. The estimates show that if, for whatever reason, routine health care is disrupted and access to food is decreased, the increase in child and maternal deaths will be devastating. The greatest number of additional child deaths will be due to an increase in wasting prevalence among children, which includes the potential impact beyond the health system, and reduction in treatment of neonatal sepsis and pneumonia.
According to the modeling, and assuming reductions in coverage in the worst-case scenario, the 10 countries that could potentially have the largest number of additional child deaths are: Bangladesh, Brazil, Democratic Republic of the Congo, Ethiopia, India, Indonesia, Nigeria, Pakistan, Uganda and United Republic of Tanzania. The 10 countries that are most likely to witness the highest excess child mortality rates under the worst-case scenario are: Djibouti, Eswatini, Lesotho, Liberia, Mali, Malawi, Nigeria, Pakistan, Sierra Leone and Somalia. Continued provision of life-saving services is critical in these countries.
In addition to the estimated potential rise in under-five and maternal deaths described in the Lancet Global Health Journal analysis, UNICEF is deeply alarmed by the other knock-on effects of the pandemic on children:
- An estimated 77 per cent of children under the age of 18 worldwide – 1.80 billion out of 2.35 billion – were living in one of the 132 countries with stay-at-home policies, as of early May.
- Nearly 1.3 billion students – over 72 per cent – are out of school as a result of nationwide school closures in 177 countries.
- 40 per cent of the world’s population are not able to wash their hands with soap and water at home.
- Nearly 370 million children across 143 countries who normally rely on school meals for a reliable source of daily nutrition must now look to other sources as schools are shuttered.
- As of 14 April, over 117 million children in 37 countries may miss out on their measles vaccination as the pandemic causes immunization campaigns to stop to reduce the risk of spreading the virus.
This week, UNICEF is launching #Reimagine, a global campaign to prevent the COVID-19 pandemic from becoming a lasting crisis for children, especially the most vulnerable children – such as those affected by poverty, exclusion or family violence. Through the campaign, UNICEF is issuing an urgent appeal to governments, the public, donors and the private sector to join UNICEF as we seek to respond, recover and reimagine a world currently besieged by the coronavirus:
- Respond. We must act now to stop the disease from spreading, help the sick, and protect first responders on the frontlines risking their own lives to save others.
- Recover. Even when the pandemic slows, each country will have to continue to work to mitigate the knock-on effects on children and address the damage inflicted. Communities will also have to work together, and across borders to rebuild and prevent a return of the disease.
- Reimagine. If we have learned anything from COVID-19, it is that our systems and policies must protect people, all the time, not just in the event of a crisis. As the world recovers from the pandemic, now is the time to lay the groundwork for building back better.
To kickstart the campaign, two of UNICEF’s valued partners - Pandora and ING - have both agreed to pledge a generous donation to show their part in answering the call to this appeal and to spur more donations from the public in the coming weeks.
“The COVID-19 crisis is a child rights crisis. We need an immediate-, medium- and long-term response that not only addresses the challenges created by the pandemic and its secondary impacts on children, but also outlines a clear version for building back a better world when the crisis finally recedes. For that, we need everyone’s ideas, resources, creativity and heart.” said Fore. “It is our shared responsibility today, to reimagine what the world will look like tomorrow.”
The paper will go live in the Lancet Global Health journal on 12 May, 23.30 UK time: http://www.thelancet.com/journals/langlo/article/PIIS2214-109X(20)30229-1/fulltext
Learn about the #Reimagine campaign here: www.unicef.org/reimagine
The authors of the Lancet Global Health study used the Lives Saved Tool (LiST) to model maternal and under-five child mortality for three scenarios in 118 low- and middle-income countries. They modelled three scenarios in which the coverage of essential maternal and child health interventions is reduced by 9·8–51·9 per cent and the prevalence of wasting is increased by 10–50 per cent. They estimated additional deaths for a single month and extrapolated for 3 months, 6 months, and 12 months
These interventions range from family planning, antenatal and postnatal care, child delivery, vaccinations and preventive and curative services. The modeled scenarios are hypothetical and do not reflect actual policies or distinguish between mitigation strategies—only that disruptions will occur.
About UNICEF’s Covid-19 Programme and Advocacy Response
The response is built around a six-point Agenda for Action that supports Governments and calls on decision-makers to:
- Keep children healthy and well nourished
- Reach vulnerable children with water, sanitation and hygiene
- Keep children learning
- Support families to cover their needs and care for their children
- Protect children from violence, exploitation and abuse
- Protect refugee and migrant children, and those affected by conflict
UNICEF promotes the rights and wellbeing of every child, in everything we do. Together with our partners, we work in 190 countries and territories to translate that commitment into practical action, focusing special effort on reaching the most vulnerable and excluded children, to the benefit of all children, everywhere.
For more information about UNICEF and its work for children, visit www.unicef.org.bd